Provider Demographics
NPI:1730178252
Name:LUTZ, STANLEY N (OD)
Entity type:Individual
Prefix:
First Name:STANLEY
Middle Name:N
Last Name:LUTZ
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:182 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:AMHERST
Mailing Address - State:OH
Mailing Address - Zip Code:44001-2230
Mailing Address - Country:US
Mailing Address - Phone:440-988-4419
Mailing Address - Fax:440-988-8020
Practice Address - Street 1:182 PARK AVE
Practice Address - Street 2:
Practice Address - City:AMHERST
Practice Address - State:OH
Practice Address - Zip Code:44001-2230
Practice Address - Country:US
Practice Address - Phone:440-988-4419
Practice Address - Fax:440-988-8020
Is Sole Proprietor?:No
Enumeration Date:2005-10-18
Last Update Date:2010-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2734T1057152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2734OtherEYEMED
580001592OtherRAILROAD MEDICARE
0356723Medicare ID - Type Unspecified
580001592OtherRAILROAD MEDICARE